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Hormone replacement therapy may increase regression after LASIK

Decreased tear production in postmenopausal women may be the primary cause for regression.

ByJared Schultz

ByMichelle Dalton

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Women who use hormone replacement therapy are at an increased risk of regression after LASIK surgery compared with women who do not use the therapy, according to a study.

Michael O’Keefe, FRCS, and colleagues at the National University of Ireland in Dublin, retrospectively studied 301 eyes of 170 patients who had LASIK for the correction of myopia to determine the effect of hormone treatment on visual outcomes.

Women on hormone replacement therapy (HRT) have been found to have the poorest outcome after undergoing PRK, but this is the first time LASIK outcomes have been studied.

“This is the first study to investigate hormonal status and refractive and visual acuity results after LASIK,” they said.

All patients were between –0.5 D and –8 D preoperatively. Patients ranged in age from 21 to 59 years and were divided into control groups, those on HRT and those on birth control pills.

The mean age of the patients in the HRT group was 48.5 years compared with 33.7 years in the control. The mean age of the women on birth control pills was 29.4 years, and that group was compared to the control group as well, according to the study.

There were 44 eyes of 27 patients on HRT; 81 eyes of 44 control group patients; and 176 eyes of 99 patients on birth control pills. The mean preop spherical equivalent (SE) refraction was –4.25 D in the groups on HRT and oral contraceptives, compared with –3.77 D in the control group, the authors said.

All surgeries were performed with the Technolas 117 excimer laser from Bausch & Lomb, and all patients were given 0.1% fluormethalone four times daily for two weeks and chloramphenicol 0.5% four times daily for five weeks.

Follow-up visits were at 1 day, 1 week, 2 months and 6 months.

Refractive and visual outcomes

At week 1, there was no difference in refractive outcome between the control and HRT groups. By month 2, however, the refractive outcome was significantly worse in the HRT group, with a mean SE of –0.34 D, than in the control group which had a mean SE of –0.18 D. That trend continued through the 6-month follow-up.

Visual acuity outcomes reflected the same, with only 20 of the HRT eyes having a VA of 20/20 or better compared with 61 of the control eyes at 6 months.

Age was found to have a significant effect on the refractive outcome, independent of HRT, the researchers said.

Conversely, neither refraction nor visual acuity differed between the control group and the oral contraceptive group, they said.

“Postmenopausal women on HRT had a poorer outcome than younger premenopausal women,” the researchers said.

Higher incidence of dry eye

The age factor in poor LASIK outcomes was attributed to the propensity for postmenopausal women to have dry eye, the researchers explained.

“The poorer outcome following LASIK surgery of the postmenopausal group in this study when compared to controls or women taking the [oral contraceptive pill] may be attributable to the higher incidence of dry eye in these women,” they said.

According to the authors, recent studies have shown that a decrease in sex hormones causes dry eye, but they said that the discovery of hormone receptors for both male and female hormones in the corneal and conjunctival tissues and in meibomian glands raises questions about why HRT does not enhance tear production.

“There is evidence that estrogen acts on lacrimal and meibomian glands, inducing lacrimal gland regression and reducing tear output,” they said.

The combination of normal postop dry eye during the first six months and reduced corneal hydration in postmenopausal women may be the culprit for poorer outcomes.

Age differences

Although birth control pills also cause hormonal changes, the authors suggest that women who take them tend to be younger than those on HRT and therefore have healthier corneas and better tear secretion.

Birth control pills may also have lower doses of hormones than HRT, but they said this was difficult to ascertain.

“It is possible that the hormone dose in the [birth control pills] is insufficient to cause any negative effects on outcome,” they said.

“We were unable to ascertain from the clinical data the preparation of HRT that was used, which may have some impact on the outcome.”

The authors recommend a prospective study to determine if a relationship truly exists between regression and older postmenopausal women.

For more information:

• Michael O'Keefe, FRCS, is the corresponding author of this study. He can be reached at Mater Private Hospital, Eccles St., Dublin 7, Ireland; +353-868-362-849; e-mail: mokeefe@materprivate.ie.

Reference:

• O'Doherty MA, O'Doherty JV, O'Keefe M. Outcome of LASIK for myopia in women on hormone replacement therapy. J Refract Surg. 2006;22:350-353.

• Michelle Dalton is an OSN correspondent based in Sicklerville, U.S.A..
• Jared Schultz is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses geographically on Europe and the Asia-Pacific region.